Preterm Birth; A Growing Threat to Our Children

Karen Schobert
Premature infants have higher health risks and face more social challenges than do infants born at full-term. Physiological causes such as low maternal weight gain and pregnancy-induced hypertension (PIH) as well as psychosocial issues including domestic violence and stress are correlated with preterm birth. The consequences of prematurity include stillborn births, infant mortality, lower academic achievement and increased rates of emotional, cognitive and physical health problems. Nurses play an essential role in providing resources, support and prevention strategies to patients at-risk for preterm birth. In order to reduce the incidence of preterm birth, it is imperative that nurses identify the risk factors associated with prematurity and educate patients and their families accordingly.
Prematurity is defined as birth occurring before 37 weeks gestation according to Rosenberg, Garbers, Lipkind & Chiasson (2005). There are various methods used to determine gestational age. The most common include using the date of the woman’s last menstrual period or by visualization of the fetus using ultrasound technology. Preterm birth is a growing problem. The March of Dimes reports that since 1981, the rate of preterm births has risen by 30%. Dr. Jennifer Howse, president of the March of Dimes, stated:
“These numbers underscore the need to address premature birth in our country with the same urgency and focus that has been brought to other threats to children’s health including secondhand tobacco smoke and rising rates of obesity”
There are multiple risk factors leading to preterm birth, many of which can be identified by nurses. Pregnancy spacing has an impact on birth outcomes. According to Gellene (2006), women who become pregnant sooner than 18 months after giving birth to an older child are at increased risk for delivering prematurely. Ricketts, Murray & Schwalberg (2005) suggest that psychosocial factors such as pregnancy-related anxiety, homelessness, domestic violence, unemployment and level of education are associated with preterm births. Women who smoke, engage in substance abuse or gain an inadequate amount of weight during pregnancy are also at risk (Ricketts, et all, 2005). Rosenberg, Garbers, Lipkind & Chiasson (2005) have found that obese women run a higher risk of delivering a premature infant due to the positive correlation with diabetes mellitus. Mothers who suffer from PIH may have to deliver before 40 weeks gestation as stated by Rosenberg, et. all, (2005), and various infections such as HIV and periodontitis, as well as the premature rupture of membranes account for a substantial number of premature births according to Ricketts, et. all, (2005). Nurses who are familiar with these various risk factors will be able to recognize a patient who has a higher probability of delivering preterm, and will be better equipped to implement early interventions.
The effects of prematurity can be seen from before birth, to well into adulthood. Gellene (2006), points out that prematurity is linked to stillborn birth as well as to a higher rate of infant mortality. Studies done by Hollo, Rautava, Kornhonen, Helenius & Sillanpaa (2002) show those children born too early tend to obtain lower academic achievement than their cohorts who were born at term. Adolescents and adults who were premature as infants have increased rates of emotional, cognitive and physical health problems according to Patton, Coffey, Carlin, Olsson & Morley (2004). Many high-risk expectant mothers and their families may not fully understand the consequences of prematurity and therefore may fail to take necessary steps toward the prevention of preterm birth. Nurses, in collaboration with other health care professionals can provide education to those at risk in order to facilitate as healthy a pregnancy as possible.
Once nurses have identified high-risk populations, such as teenagers, smokers, substance abusers, obese and underweight women and low income patients, they can provide these women and their families’ with strategies to avoid complications leading to preterm birth. Education related to smoking cessation, appropriate caloric intake, physical activity during pregnancy and early warning signs of preterm labor can benefit patients. Nurses can also provide patients with resources to turn to for help, such as support groups for adolescent mothers, rehabilitation for drug or alcohol dependencies and counseling for psychosocial issues.
Since many premature infants have health problems and face lifelong developmental challenges, it is imperative for health care providers to educate patients and their families about the risk factors and health effects associated with preterm birth. Nurses play an important role in providing resources, support and preventions strategies to patients at risk for preterm birth. By identifying specific risk factors leading to preterm birth, providing patients with information related to the effects of prematurity and by collaborating with women to create strategies to avoid preterm birth, nurses can have a positive impact on pregnancy outcomes and help to safeguard the health and well-being of generations to come.
Intervention 1: There are multiple risk factors leading to preterm birth, many of which can be identified by nurses.
Disadvantage 1: However, certain situations such as a patient’s income level and subsequent lack of insurance can inhibit women from seeking prenatal care and this eliminates the opportunity for nurses to intervene in the clinical setting. According to Klitsch (2000), many low-income women initiate prenatal care late or do not receive it at all. Lack of insurance puts both nurses and pregnant women at a significant disadvantage. Ciro Scalera, executive director of the Association for Children of New Jersey points out that in order to identify the women at risk who are not receiving prenatal care,
“you need some kind of much targeted outreach effort at a community level with community people”.
Disadvantage 2: A patient’s socioeconomic status presents additional challenges to nurses who are working to identify women at risk for preterm birth. For patients who do seek prenatal care, some may choose not to disclose information pertaining to problems such as homelessness, unemployment, substance abuse or domestic violence. While anxiety related to socioeconomic problems puts women at a higher risk for preterm birth (Dole, et. All, 2004) many women will elect to withhold anxiety-related issues from their health-care providers for reasons including differences in gender-related social norms, social support structures, and experience with discrimination (Perreira & Cortes, 2006)
Intervention 2: Nurses can provide education, resources and prevention strategies to help women avoid preterm birth.
Disadvantage 1: One barrier to this intervention is the patient’s knowledge deficit relating to the seriousness of the problem. For example, Leiner, Villa, Singh, Medina & Shirsat (2007), conducted a study on the knowledge levels of teenage mothers and pregnant teens regarding the risks of tobacco use during and after pregnancy. The results of the study indicated that the messages about the risks of exposure to cigarette smoke during and after pregnancy are not well understood by teenage mothers and pregnant teenagers. Ninety-four percent of the study group declared that they were informed about the risks of smoking during and after pregnancy. Their information came from doctors, books, television, school-specific programs, relatives, teachers, health education programs outside of the school and on the internet. Despite the information received, a knowledge deficit remained. Health care workers and nurses in particular need to look for alternatives to improving communication among high-risk groups.
Disadvantage 2: A second barrier that nurses face when attempting to provide education, resources and prevention strategies can be found in both environmental racism and racial discrimination. New Jersey Governor Christie Whitman released a report on infant mortality in 1997 which theorized that the stress from racism could cause women to have health problems that lead to premature births. Dr. Diane Rowley of the Centers for Disease Control and Prevention states that
“Environmental racism puts many Blacks in neighborhoods where there are high levels of toxins: and many Blacks live in high crime areas that create stress in their lives” (Sun Reporter, 1999).
Moreover, Governor Whitman’s report stated that black women, whose infant mortality rate is over 2.5 times higher than whites (Sun Reporter, 1999)
“have also watched their mothers, sisters, aunts and friends lose their babies. They figure there is little they can do about it” (Sentinel, 1997).
The logistical complications and resigned thought process that this example illustrates presents a unique challenge to nurses.
References:
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Rosenberg, T., Garbers, S., Lipkind, H., & Chiasson, M. A. (2005). Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health. 95(9), 1545-1551. Retrieved April 13, 2006 from Proquest Platinum Full Text Periodicals database.
Little, M., Shah, R., Vermeulen, M.J., & Gorman, A. (2005). Adverse perinatal outcomes associated with homelessness and substance use in pregnancy. Canadian Medical Association Journal. 173(6), 615-618. Retrieved April 28, 2006 from Proquest Platinum Full Text Periodicals database.
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Leiner, M., Villa, H., Singh, N., Medina, I. & Shirsat, P. (2007). Pregnant Teenagers and Teenage Mothers: How Much They really Know About the Risks to Children’s Health Associated With Smoking During and After Pregnancy? The Journal of School Health. 77(3), 101-102. Retrieved October 22, 2007 from Proquest Platinum Full Text Periodicals database.
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